Introduction
Abnormal Uterine Bleeding (AUB) is a common yet often overlooked gynecological condition affecting women of all ages. It refers to any bleeding from the uterus that is irregular in volume, timing, or duration and differs from a woman’s normal menstrual cycle. AUB can significantly impact quality of life and may be a symptom of underlying health issues that require attention.
What Is Normal Menstrual Bleeding?
Understanding what constitutes normal menstrual bleeding is essential to identify abnormalities. A typical menstrual cycle lasts between 21 to 35 days, with bleeding lasting 2 to 7 days. The average blood loss per cycle is about 30-40 mL. Cycles that are regular, with predictable timing and flow, are generally considered normal.
What Is Abnormal Uterine Bleeding (AUB)?
AUB refers to any deviation from a regular menstrual pattern. This includes heavier or lighter bleeding than usual, bleeding between periods, prolonged periods, or bleeding after menopause. It can also include irregular periods that are unpredictable in timing or amount.
Types of Abnormal Uterine Bleeding
- Menorrhagia: Excessive menstrual bleeding
- Metrorrhagia: Bleeding between periods
- Polymenorrhea: Frequent periods (less than 21 days apart)
- Oligomenorrhea: Infrequent periods (more than 35 days apart)
- Postmenopausal bleeding: Any uterine bleeding after menopause
Causes of AUB: The PALM-COEIN Classification
The FIGO classification system categorizes AUB causes into structural and non-structural categories:
Structural Causes (PALM):
- P – Polyp: Benign growths in the endometrial or cervical canal
- A – Adenomyosis: Endometrial tissue within the uterine muscle
- L – Leiomyoma (Fibroids): Benign tumors in the uterus
- M – Malignancy and Hyperplasia: Abnormal or cancerous cell growth in the endometrium
Non-Structural Causes (COEIN):
- C – Coagulopathy: Blood clotting disorders
- O – Ovulatory Dysfunction: Irregular ovulation, common in PCOS or thyroid issues
- E – Endometrial: Primary disorders of the endometrium
- I – Iatrogenic: Medication-induced bleeding (e.g., hormonal therapy, anticoagulants)
- N – Not yet classified: Rare or unknown causes
Symptoms and When to See a Doctor
Common symptoms include:
- Bleeding between periods
- Very heavy menstrual flow
- Periods lasting longer than a week
- Bleeding after intercourse
- Postmenopausal bleeding
Seek medical attention if these symptoms occur frequently or disrupt daily life.
How Is AUB Diagnosed?
Diagnosis involves a combination of medical history, physical exams, and diagnostic tests such as:
- Pelvic ultrasound
- Blood tests (CBC, thyroid, hormone levels)
- Pap smear
- Endometrial biopsy
- Hysteroscopy
Treatment Options
Treatment depends on the cause, severity, and the patient’s reproductive goals:
- Medical Management:
- Hormonal therapies (oral contraceptives, progestins)
- Antifibrinolytics (e.g., tranexamic acid)
- NSAIDs to reduce bleeding
- Surgical Management:
- Polypectomy, myomectomy
- Endometrial ablation
- Hysterectomy (in severe or non-responsive cases)
AUB in Different Age Groups
- Adolescents: Often due to immature hormonal axis and anovulation
- Reproductive-age women: Causes include PCOS, fibroids, or hormonal imbalance
- Perimenopausal and Postmenopausal: Higher risk of malignancy, requires thorough investigation
Complications of Untreated AUB
- Anemia: Due to chronic blood loss
- Fertility issues: Especially if caused by hormonal or structural problems
- Increased cancer risk: Especially in postmenopausal women with untreated hyperplasia
Prevention and Lifestyle Considerations
- Maintain a healthy weight
- Manage chronic conditions like diabetes or thyroid disorders
- Avoid unnecessary use of hormonal medications
- Regular gynecological checkups
Conclusion
Abnormal Uterine Bleeding is a symptom that should never be ignored. Early diagnosis and appropriate treatment can significantly improve quality of life and prevent serious complications. Women are encouraged to pay attention to their menstrual patterns and consult a healthcare provider if they notice anything unusual.
Frequently Asked Questions (FAQs)
1. Is abnormal uterine bleeding the same as heavy periods? No. Heavy periods (menorrhagia) are just one type of abnormal uterine bleeding. AUB can also include irregular timing, bleeding between periods, or prolonged bleeding.
2. Can AUB be a sign of cancer? Yes. While most causes are benign, AUB, especially in postmenopausal women, can be a sign of endometrial or cervical cancer and should be evaluated.
3. Does AUB affect fertility? It can. Causes like PCOS or fibroids may interfere with ovulation or implantation, affecting fertility.
4. Is AUB treatable? Yes. Treatment depends on the underlying cause and can range from lifestyle changes and medications to surgery in severe cases.
5. Can stress cause abnormal uterine bleeding? Yes. High stress can affect hormonal balance and ovulation, leading to irregular menstrual cycles.
6. When should I worry about irregular periods? You should consult a doctor if irregular periods are frequent, very heavy, prolonged, or occur after menopause.
7. What tests will a doctor recommend for AUB? Common tests include pelvic ultrasound, blood work, Pap smear, endometrial biopsy, and sometimes hysteroscopy.
8. Can birth control help with AUB? Yes. Hormonal birth control methods can help regulate cycles, reduce bleeding, and treat some underlying hormonal imbalances.
9. Should I track my periods? Yes. Keeping a menstrual diary helps identify abnormalities early and is useful for diagnosis.
10. Can diet and lifestyle changes improve AUB? Yes. Maintaining a healthy weight, managing stress, and treating conditions like thyroid disorders can help regulate menstruation.
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